Last week was the end of block test week, and at the very end of the week, on Friday, I left for Mexico, Missouri for my church's annual 22-hour retreat. For the last two years it has been perfectly scheduled to coincide with the very end of test week and the beginning of break week, and both times so far has been an incredibly refreshing way to escape the world of academic medicine and the bustle of the city. "Cell phones don't work out here," I mused on the drive out to the camp.
The camp where we hold our retreat is several small buildings owned by a Baptist church group out that way that allows us to use it each year. The property is the size of several football fields, with a creative array of fields, wooded hollows, remnants of a creek and some runoff lanes between rises in the ground. There's a lake with a dock that is the perennial wilderness baptismal. There's also a barn-like building that now serves as a chapel. A firepit next to an outdoor ampitheater, the fellowship hall, and a small group of three cabins rounds out the scenery.
After having the night's turkey feast, and the first sermon of the retreat, it was dark and a chill was finally developing. I headed to my friend Jesse's Jeep for my fleece to help fight off the night's cold. Walking back towards the fellowship hall, I started hearing my name, and approaching the light of the open door was spotted by my friend Ryan, who ran to greet me and alert me that I was needed. As I followed him into the hall, a young man was brought before me by my pastor John. With his left eye starting to swell, the white of his eye a uniform pink-red, and a trail of blood flowing from the outside corner down to his jawbone, I immediately knew why I was so urgently sought; the man needed medical care, and I was expected to provide it.
The young man had been hit by a hedge apple about the size of a softball in the dark (apparently, some people were throwing hedge apples around for fun). My stomach clenched a bit at the first sight of him. "What if I don't know what to do? What if I can't be of help?" I thought. I was afraid to let him and everyone expecting me to help down. Very quickly though, I put all that aside in favor of an air of authority and control as I asked for a flashlight. My pastor informed me that there was a better lit first aid room in the basement, stocked with medical supplies. He beckoned with his hand and led me and the young man down the stairs to the room. The room had a couple chairs, a cabinet with a stock of general first aid supplies, and a large examining lamp anchored to a desk corner. Soon Korrin and her husband Cannon (A nurse and a fireman with some EMT training, respectively) and my friend Ben (also with EMT training) arrived.
As we started to undertake cleaning the wound and examining the young man's eye, it became apparent how much respect was being deferred towards me and my decisions. I also became aware of my own initiative to direct the care of the young man. Thus it became evident the weight the white coat carries in a medical situation.
It is hard to find anyone who hasn't heard the proverbial question "Is there a doctor in the house?" in passing, but seldom ever do people hear it in honest inquiry. One time when I was in high school I saw it employed; at a chorale competition in the gymnasium in front of a crowd of families and friends from the competing schools, my assistant director rushed in from the hallways to announce that a lady had collapsed, and inquired if there were any doctors available. At least two, if not three if I remember rightly, quickly made their way from their seats to the scene. I can liken that scene now, roughly eight years ago, with what happened this past Friday night. The profession of physician extends beyond the realm of the office and the examining room, beyond the halls of the wards and the beds of the trauma unit. Once a physician it is an expectation that in the immediate presence of a medical emergency you appear like an expected hero, with the calm and the knowledge to handle the concern in an instant. Not even awarded the title of M.D. yet and I already feel this expectation.
Maybe this event seems different simply because of the blood. There's been numerous times stretching back to before even entering medical school that friends have approached me with a medically oriented question. Sometimes it's been because of an injury while out playing sports; a twisted or bruised limb is especially common. But the blood is different. People react. Some faint, some feel nausea, others panic. The doctor is expected to fulfill his role of hero and savior and not be bothered by the blood. The doctor is expected to be the leader as the first responder. His degree and his pay and his years of study preceed him in many people's minds to the point where it is a crime now to be considered fallible. Fallibility isn't a characteristic of a doctor, but negligence is.
Soon, patient encounters will occur on a routine basis within the hospital, but I will be the student in a world of professionals who know my fallibility. Slowly though, as the tails of my white coat grow (which is set to happen in May of 2009) and my presumed knowledge and authority increase (sometime after residency) there will be more people who will defer to my expertise, and I will have no choice but to shoulder the responsibility. Patient's and nurses and residents and medical students will all at some point lean to my authority. The implications of that are beginning to reach me, and I am deeply humbled.
