One glance

Four classmates and I were swapping stories at our table in a restaurant, unwinding after taking a major exam. One of us was still in his scrubs, and our waiter, overhearing our conversation, asked if we were medical students. When we responded in the affirmative, he told us that his mother recently had been diagnosed with a brain tumor and had to get it surgically removed. "It was so stressful waiting for the neurosurgeon to come into the waiting room and tell me and my dad how the procedure turned out," he told us.

"Finally, he came out, and his face was a total blank. Absolutely no expression. Couldn't read anything. I guess that's what he has to do, but those fifteen seconds when the surgeon walked over felt like an hour. With each step I kept feeling like something must have gone wrong, my mom must be dead.

"Then he pulled my father aside, and said that everything went great. I was so mad at him that I wanted to punch him, but I was so happy with what he said that I wanted to dance. I can't believe what that guy put me through."

Our once-boisterous table fell silent.

Some weeks back, a professor had told us that practicing medicine is privilege and a burden--you can restore life or take it away, and with one glance or a few words you can alter someone's life, for better or for worse. He told us that people will treat us differently and expect more of us, just because we will be medical students and doctors.

Our waiter just wanted to tell us his story. And without knowing it, he had reminded us that our professor was right.

Walking through the Valley of the Shadow of Death

"Medical student syndrome" is a mainstay of medical training--many students become convinced that they or those around them are experiencing the symptoms of some of the diseases they study. I don't feel like I am suffering from the syndrome, but learning the sheer variety of diseases has made me more frightened of succumbing to one. I had been blissfully ignorant of most of the myriad ways our extraordinarily complex body fails. I now find myself worrying more about aging and about those I love falling ill.

This "walk through the valley of the shadow of death" is part of the burden and privilege of medical training. Soon we will be assuming shared responsibility for our patients' well-being, and we must know their enemies to best protect against them.

Fretting that things might be more serious than they appear can be a mark of a good physician. If a teenage patient breaks his femur while playing football, it's one thing to repair the leg and cast it. It's rather another to step back and wonder if the bone had broken because it was weakened (perhaps by cancer or an endocrine disorder). Seemingly innocuous complaints (muscle twitches in the leg) can have unlikely but serious conditions in their differential diagnosis (Lou Gehrig's disease). This decision of whether to pursue a case further is informed by years of experience, something I currently lack.

I was taught that one needs to feel concern in moderation--too much worry is disabling and too little is reckless. I hope to strike the right balance, for my sake and for my patients'.

Responding to mass-casualty plane crashes

It heartens me to see the medical community's tremendous response to extraordinarily demanding disasters. The recent Reno airshow crash sent 35 patients, many of them grievously wounded from complex trauma, to a particular hospital's emergency department. Reno's main newspaper described the situation inside the ED in a riveting article.

The ED began preparing for patients as soon as they received word of the crash, and an automated telephone system requested that all of the hospital's emergency medicine physicians come in immediately. Physicians from all types of specialties flocked to the hospital unasked so that they could be on-hand. What resulted was remarkably efficient and collaborative care.

I'm reminded also of the 1989 crash of United Flight 232 in Sioux City, IA. 296 people were aboard the DC-10, which due to improper maintenance lost its tail engine and all of its hydraulics. This meant no flight controls (throttle, rudder, elevators, ailerons), no landing gear, and no brakes. The only thing the pilots could control was the amount of fuel going to their two remaining engines. By opening and cutting off the fuel lines, the pilots were able to very crudely control their altitude and somewhat guide the plane, which was constantly turning right. Through a combination of sheer luck, skill, experience, and assistance from air traffic control, the pilots guided the plane over Sioux Falls airport and crash-landed.

Approximately 200 survivors were rushed to Sioux City's hospital. Physicians, in turn, rushed in to help assist. There were so many physicians on hand that the hospital director arranged for a plan: each arriving patient would be met by a team of a doctor, a nurse, and a technician. This team would remain with the patient until they were either discharged from the hospital or admitted. Miraculously, 184 passengers lived.

Sioux City had conducted a mass-casualty simulation a little over a year prior to prepare its emergency response services. The scenario: a passenger aircraft crash-landing at Sioux City airport.