Every doctor that I have ever talked to, can recall their first patient in vivid detail. Probably a result of the adrenaline wave that accompanied it, they remembered the trivial facts, the conversation, and the diagnosis as clear as if they had just walked, sweating, out of the room. At our institution, we did things a bit differently and had the unique distinction of sharing our first patient within the first few months of medical school.
As a part of our Musculoskeletal and Integument block, our professors recruited a number of their patients to come into the med school and let us examine them. They spread themselves between our dozen or so ‘interaction rooms’ and we proceeded in small groups from room to room. It felt strange, almost like we were moving between staged animatronic scenes in a Disney World ride. One room held a young amputee and her orthopedic surgeon. The next, an over-enthusiastic rheumatologist displaying polarized slides of synovial fluid. Another, a dermatologist and his recently cancer-free patient. It was all a bit overwhelming and I found myself distracted by the novelty of it all. By the time we had rotated a few times, the patients and the doctors began to sound mechanical, having repeated their stories again and again, but even so, we were so buzzed about the idea of seeing real patients that we hung on every word.
This was the first time that the material jumped off of our annotated PowerPoint slides and into our lives. One patient, in particular, stands out–one of the last that my group saw. He was a heavyset, middle-aged man, dressed in a dull flannel shirt and jeans that were rolled up to mid-calf to better expose his bare feet. They had situated him on a high chair, and more than any of the other patients, he resembled a specimen on display. Something he seemed acutely aware of.
If the other patients seemed animatronic in their delivery, then he was a disgruntled back-room worker caught up in the display. My initial impression was that he was some kind of construction worker with knobby, calloused hands, but as I reached out to greet him I realized that his hands were soft and swollen with burning rheumatoid nodules. He had Rheumatoid Arthritis, and as his doctor explained to us, he had the most extreme form of RA that we were likely to see. He perked up at this and nodded at this as if it were a morbid point of pride. “I’m at a 7 out of 10 pain just about every day, and now after I’ve been touched over and over again it’s probably a 9. Especially in my feet,” he said curtly.
“Show them your feet,” the doctor prompted soothingly, and he obliged, holding out a red, tense foot, with mangled toes that twisted outward like branches warped by some unseen force.
There was a collective cringe as we all observed the way he grimaced as the doctor demonstrated his pathology. We were all silent, stifled by an oppressive feeling of pity that we were then unequipped to manage. Eventually, the conversation turned to his treatment and we all perked up. Cold clinical facts where what we knew best, and divorced from the discomfort we felt in the presence of suffering, we asked our questions.
“How long have you had RA?”
“Do symptoms usually stay this severe when patients are being treated?”
“Aren’t combination therapies more effective than monotherapy?”
“Could he try a biologic?”
“Are there shoes that would ease his symptoms”
“Is there anything?”
It took us a while to realize that what we were asking was impossible. We had seen the treatment algorithms, but we lacked experience with medicine in the real world. In our naiveté, we failed to consider the insidious factors that cause good treatments to fail. Non-compliance, lack of access, and above all, cost, all combined to leave this man before us, clenched in pain that would not cease.
We were silent…and remained so. Somewhere an alarm sounded and we were moved on to our next patient experience, but even as new patents told new stories, a part of the innocence that we had felt just minutes before, remained in that room with the 9 out of 10 pain of poverty.
We found out later that this was a new initiative–to expose us to patients at an early phase of our education. The powers that be, worried that we would be too hung up on studying for our exams and that we would resent the intrusion onto so much of our time. But rather than coast through these encounters, we took them as our first honest invitation into peoples’ lives. They became our first patients, and we struggled to make ourselves worthy.
Maybe every physician feels a gnawing sense of responsibility for their first patient that exceeds the normal call of duty, or maybe we were just so green that we hadn’t learned where to draw the line. Whatever the reason, as a class we decided to step up. We went into medical school to help people regardless of what that entailed, so when one of our classmates posted in our class Facebook group that she was collecting donations for orthopedic inserts for that patient’s shoes, we all jumped at the idea. We determined that we could buy a new pair of shoes with orthopedic insoles for about $200, so we set that as our initial goal.
We reached our mark in about half an hour.
With the combined effort of the 130 student-doctors, we raised over a thousand dollars in the next two days, and with it we were able to buy two pairs of shoes, orthopedic insoles, winter clothes, bus passes, and an appointment to a podiatrist. Maybe every patient can’t have a fundraiser, but in this experience, we learned that there is more to medicine than pills and procedures. With our first patients, we glimpsed the fullness of the doctor-patient relationship and the intrinsic reward of helping someone in need.
As the months of medical school wound on, we were able to look back fondly on these experiences, and take comfort in the fact that one day all of our struggles would be worth it. The warmth we felt from our first patients was addicting, and we all have come to crave it.
