Travels Read Free Page B

emotional aspect seemed more like hazing, like a professional initiation, than education. It was a long time before I understood that how a doctor behaved was at least as important as what he knew. And certainly I did not suspect that my complaints about medicine would eventually focus almost entirely on the emotional attitudes of the practitioners, and not their scientific knowledge.

A Good Story
 
    The first part of a student’s clinical work involves interviewing patients with various diseases. The resident on the floor says, “Go see Mr. Jones in room five, he has a good story”—meaning that Mr. Jones can give a clear history for a specific disease. Off you go to find Mr. Jones, take his history, and diagnose his illness.
    For a student beginning work in a hospital, there is considerable tension in interviewing patients. You’re trying to act professional, as if you know what you’re doing. You’re trying to make the diagnosis. You’re trying not to forget all the things you’re supposed to ask, all the things you’re supposed to check, including incidental findings. Because you don’t want to come back to the resident and say, “Mr. Jones has a peptic ulcer,” only to have the resident say, “That’s true. But what about his eyes?”
    “His eyes?”
    “Yes.”
    “His eyes, hmmm …”
    “Did you check his eyes?”
    “Uh … sure. Yes.”
    “Notice anything about them?”
    “No …”
    “You didn’t notice his left eye is glass?”
    “Oh. That.”
    To avoid these embarrassments, and to make the job easier, all students quickly learned certain interviewing tricks. The first trick was to get someone to tell you the diagnosis, so you wouldn’t have to figure it out for yourself. Knowing the diagnosis took a lot of the pressure off an interview. If you were especially lucky, the resident himself would let it slip: “Go see Mr. Jones in room five; he has a good story of peptic ulcer.”
    Or you could throw yourself on the mercy of the nurses:
    “Where’s Mr. Jones?”
    “Peptic ulcer? Room five.”
    Then there might be relatives in the room when you arrived. They were always worth a try. “Hello, Mrs. Jones. How are you today?”
    “Fine, Doctor. I was just talking with my husband about his new ulcer diet when he goes home.”
    And, finally, the patients generally knew their diagnoses, and they might mention it, particularly if you walked in, sat down, and said heartily, “Well, how’re you feeling today, Mr. Jones?”
    “Much better today.”
    “What have the doctors told you about your illness?”
    “Just that it’s a peptic ulcer.”
    But even if the patients didn’t know their diagnoses, in a teaching hospital they had all been interviewed so many times before that you could tell how you were doing by watching their responses. If you were on the right track, they’d sigh and say, “Everybody asks me about pain after meals,” or “Everybody asks me about the color of my stools.” But if you were off track, they’d complain, “Why are you asking me this? Nobody else has asked this.” So you often had the sense of following a well-worn path.
    But even if you figured out the diagnosis, there was always an exciting uncertainty about interviewing patients. You never knew what would happen. One day the resident said, “Go see Mrs. Willis, room eight; she has a good story of hyperthyroidism.”
    I walked down the hallway, thinking, Hyperthyroidism, hyperthyroidism, what do I know about hyperthyroidism?
    Mrs. Willis was a thin thirty-nine-year-old woman, sitting up in bed, chain-smoking. Her eyes were bulging. She was edgy and appeared unhappy. Her dark tan highlighted the many slashing scars on her arms and face, presumably the result of a bad automobile accident.
    I introduced myself and started to talk to her, focusing on thyroid questions. The thyroid regulates general body metabolism and it affects skin, hair, voice, temperature, weight, energy, and mood. Mrs. Willis gave