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P R O B E
• V o l . L I I I • N o . 3 • A p r – J u n 2 0 1 4
this proficiency did not extend
to understanding anything. The
only 2 possibilities in my fledgling
differential diagnosis—tuberculosis or
lung cancer.
If the spherules of
Coccidioides
immitus
had waited to announce
their presence until after second-year
pathology, my hemoptysis differential
would have been much longer and my
concern much less. Unfortunately, at
the time I knew just enough to panic.
Matters didn’t improve when the films
ordered by my internist prompted
an immediate pulmonology referral
along with queries about my HIV
status. And even after a diagnosis of
chronic pulmonary cocci, the specter
of uncertainty remained. Over the
course of the next 8 months, my
medical history, dutifully documented
by a flood of insurance paperwork,
included periodic LFTs, PFTs,
imaging studies, and bronchoscopy.
I had anomalous X-rays, a bout of
pleuritis that sent me to the ED to
rule out pulmonary embolism, and
pneumonia from an unidentifiable
organism. I gave blood samples and
sputum samples and wondered, as I
followed the recorded instructions of
the CT scanner yet again, what the
radiologist would find this time. It is
disconcerting to have a cavity in one’s
lung, but it is even worse to think
about it growing or a microorganism
freeloading inside of it. Worst of all
is the wondering after each round
of tests. Was it normal? Is there
something there? Am I okay?
And when my telephone rings
and I recognize the voice of my
pulmonologist, it wouldn’t matter
if he was calling to tell me I do have
TB or lung cancer because at least
then I would know. The first time
he called we had not yet met. When
he introduced himself, explaining
that he was calling to make sure I
would be okay until my scheduled
appointment a few days later, I was
momentarily too surprised to say
anything comprehensible about my
symptoms. A physician making an
after-hours phone call to an unknown
patient, primarily for reassuring
purposes? In the months ahead I
received many more calls, keeping me
informed of normal and abnormal
results, the rationale for additional
tests, and changes in medication. My
long and rambling messages on the
pulmonary nurses’ phone line were
always returned with the answer about
an appointment, scheduled procedure,
or prescription refill that I needed.
Like everyone else I loathe being
sick, but the relief of knowing what
is happening to me as it happens is
profound.
Medical students are told that one
of the most difficult aspects of being
a patient is the uncertainty, the not
knowing what is happening, the
loss of control. Communication is
paramount, we learn, part of the
biopsychosocial model presented in
the first week of classes when everyone
takes notes because this is medical
school. It makes obvious sense then,
in the isolation of a lecture hall,
miles removed from the raw reality of
medicine and the questions, the fears,
the confusion that accompany the
spectrum of diseases and diagnoses we
are all so eager to learn. Yet I wonder,
in this age of technology and cell
phones and caller ID, how often each
of us has silenced a ring or delayed
taking a call until a time judged
more convenient. Was it last week,
yesterday, or this morning that the
promise of “Coffee tomorrow?” was
offered and accepted between friends
who know that tomorrow may always
be tomorrow and never today? In this
upside-down wonderland of becoming
a physician, is communication
truly that important when in other
circumstances we so often survive
without it?
I will never be able to forget that it is,
far more so than the positive prognosis
or pronouncement of a good outcome
that are often mistakenly assumed
to matter most. Patients may want
good news from a physician, but what
we need is news, period. The ancient
Egyptian physician Imhotep was so
revered for his knowledge that after
his death he was worshiped as god.
While the attitude toward physicians
may have changed since 2600
BC, the ability and corresponding
responsibility of a physician to provide
answers to a patient’s questions have
not.
I started medical school thinking
those answers had to be perfect,
the ultimate goal, or so I thought,
of a period of training that spans
more years than I care to count. Yet
somewhere along the way, as I studied
by creating mnemonics for my own
disease and swallowed twice a day—
the real version of the compounds
represented on my PharmCards,
my representation of excellence, the
image of the puzzle I am trying to
complete, has been indelibly altered.
For, while the achievements I study
every day as a medical student are
remarkable, the final impact they have
on my on-again, off-again status as a
patient are not. I can study the science
of medicine and ask innumerable
questions about it—if physicians are
said to be difficult patients, medical
students must surely be worse—but
this perspective is that of my student
self, not that of the patient I don’t
want to admit that I am. In the end,
it is neither the mechanism of my
impressively expensive medication
nor the stunning resolution of the
fiberoptic camera used to visualize my
lungs that make a difference. What
matters here, in this place of feeling
sick and tired and sometimes scared,
is when the person who knows what is
happening takes the time to make sure
that I do too.
