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Pathology vs. patients: Balancing morbid fascination with heart-felt care

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

3690107655_eef7c24702_zI recently saw a patient who, against all odds, survived an aortic dissection. Miraculously, he was alive after the wall of his aorta — the largest and most important vessel in the body — began to rip apart. Aortic dissections are so violent and agonizing that a large portion of these patients don’t survive. Yet somehow, my patient was still able to sit upright in his chair and recount his story to me just a day after his surgery, a testimony to how far medicine has advanced and to how lucky he was.

I admit that I was more fascinated by his cardiovascular travails than I was concerned by his suffering and the long road of recovery awaiting him. After all, it was only a few months prior that we learned the pathophysiology of aortic dissections. And now in front of me was a real life case study accompanied by authentic lab values, imaging, and physical exam findings, all of which were free for me to probe.

Had I encountered him prior to medical school, I would have spent more time to express words of support and sympathy — he’s a survivor and he needed any and all means of encouragement to return to some semblance of normalcy.

Once we have reached the end of the journey, the patient himself is buried underneath our medical knowledge and the disease has seized all our attention.

But medical school, for better or worse, changes your perception of patients and their plights. Despite all the efforts in the curriculum to teach us to view the patient as a whole, the endless nights and sacrificed weekends of burying ourselves in textbooks and scrambled jargon eventually dehumanizes patients and forces the spotlight on the pathology.

Call it insensitivity or callousness, but this morbid fascination with human illness is one of the paradoxes in medicine — that we must sympathize with the patient as well as with the disease that is harming him and may eventually kill him.

And for better or worse, becoming a competent doctor requires some modicum of this perverse curiosity, a veritable double-edged sword. Anyone who lacks it would simply not be able to survive four years of college dedicated mostly to studying basic biology, another four years of medical school to studying clinical presentations, and then finally another handful of years to specialize, all the while taking on hundreds of thousands of dollars in debt and sacrificing young adulthood. Yet, insidiously, once we have reached the end of the journey, the patient himself is buried underneath our medical knowledge and the disease has seized all our attention.

Every now and then in class, our professors would push around a cart with preserved specimens — livers, uteruses, limbs, brains, hearts, lungs, or any other part of the human anatomy.

Often the organ, most of them taken post-mortem, is riddled with pathology — white, solid specks from a metastatic cancer or discolorations from an infection or an infarction. And like clockwork, we would form a tight circle around the professor, stand on our toes to get a good view, and respond with oohs and aahs. Under the guise of learning, these human specimens were neat, wonderful, interesting, and sometimes even “cool.” Alas, we forget too quickly that behind every specimen was once a living human being — that the uterus may have belonged to a mother who passed away from cancer and the brain to a brother who passed away from a stroke.

The medical profession requires us to see the patient and his pathology simultaneously and each with equal intimacy. The doctor becomes both a thinker and consoler and it will be up to us the practitioners to find that balance, a difficult and delicate task. In fact, finding that balance will very likely take all four years of medical school and beyond.

And that perhaps is the single most important lesson for us doctors in training, one that we can’t learn from our lectures or textbooks.

Steven Zhang is a second-year medical student at Stanford. When he’s not cramming for his next exam, you can find him on a run around campus or exploring a new hiking trail.

Photo by Edward Leung

 

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