While discussing my experiences in medical school at a recent dinner, one of my professors asked me, “Did you learn more from textbooks or patients?”
The answer was obvious: patients.
Over the course of medical school, I spent two years working in classrooms, libraries, and labs to memorize details of medical conditions and treatments and two years working in hospitals and clinics to help provide care for real patients. Even though world-class physician-educators surrounded me throughout this time, my patients taught me the most important lessons.
Patients helped translate medical facts into reality. The mnemonics I used to study for tests morphed into patients’ faces and stories that cemented the details in my mind. I don’t remember exactly when I first memorized the side effects of naproxen, a common anti-inflammatory medication, but clearly remember my first patient with kidney failure from taking too much of the medication. His story, like so many others, put a face and a name to previously abstract information and made it impossible to forget.
A heroin addict taught me more about the limits of modern medicine than any lecture on the social determinants of health. He was hospitalized for an infection from “muscling,” injecting heroin directly into muscles after not finding large enough veins, and he left the hospital against medical advice after a few days, before his wound healed and before he finished his antibiotics. I worked hard to find him a place in a rehab center, and I remember my frustration as I watched him leave, knowing a few hours later he’d again be homeless, using drugs, and unlikely to return for follow-up care. We work with patients for brief moments in their complicated lives, and this patient showed me the uphill battle we often fight against everything happening outside the hospital walls.
Patients also taught me about humanity. One of my first patients was a young child who came to us after her parents noticed an unusual set of symptoms: worsening coordination, uncontrollable eye movements, and regression from developmental milestones. I remember the look on her father’s face when we told him every parent’s worst nightmare: His daughter had a neuroblastoma, a rare, often-fatal tumor. I tried to imagine myself in his shoes, and I wasn’t sure how anyone could face the world after such devastating news. The next morning, he showed me how to do it through his determination to do everything he could to support his daughter. At this point in my training, I’ve seen many patients rise in the face of seemingly insurmountable obstacles. Their ability to keep going has taught me about human strength, dedication, and resiliency and showed me the extraordinary lengths we will go for loved ones when circumstances demand it.
Most importantly though, patients continuously reminded me why I chose to pursue a career in medicine and taught me why our work is so important. These reminders gave me critical motivation during the many difficult moments of medical school. When I think back to what got me out of bed at 3 a.m. on the many days when I was tempted to just hit snooze, it was often thoughts of patients’ hopes and goals and how I might be able to help them make progress that day.
There were many times in medical school when I wanted to tell my patients “thank you” for everything they shared, but too often time constraints or my own hesitation prevented me from doing it. As I graduate this week, I want to say what I so often felt: To every patient who sat calmly as I practiced a new skill, thank you for your patience. To every patient who took the time to explain intimate details of your life, challenges you face, and your hopes for the future, thank you for your trust and vulnerability. And to every patient who offered encouragement and gratitude, thank you for giving me the confidence to become a better doctor.
Tom Roberts is a graduating MD/MBA candidate at Stanford. He will be doing his residency in internal medicine at Massachusetts General Hospital.
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