On Tuesday I had my third day in the pediatrics pulmonary clinic. I am grateful for the experience I have had there. I have been given a lot of practice in interviewing and examining patients that I would not normally have in my APD class. The first time there, I was nervous and avoidant of seeing any patients by myself. This Tuesday, however, I saw several alone before they were seen by the doctor, and prior to being seen by the doctor would return and give him the rundown, a.k.a. presenting the patient. I was getting better even as the morning wore on. One thing challenging about pediatrics is that your patient is often only a third your size with a will and defiance five times your own, making for a formidable adversary. When you ask an adult patient to comply with a request, generally they will without much hesitation. When you ask a child, you are first faced with putting the request in a manner they will understand. Second, you must ask it in a way that they will comply with. That's the real challenge. I have grown far better with this, and also in my ability to be relaxed in seeing patients and in conducting a clinic visit. I know what use certain questions have, I know how to lead an interview, and I am becoming more and more comfortable with conducting a physical exam. Of course, it becomes far more complicated when you meet that child who won't have anything to do with you, and will let the whole clinic know with a blood curdling scream.
I've noticed in the last year that I react very differently to hearing news that a family member, friend, or friend's family member is sick. When I first started medical school I was more concerned about the disease. Now, having amassed far more medical knowledge, I find that what the disease is and how it is progressing is far less interesting than how the person who's sick and their friends and family are doing. It's not something explicitly taught in medical school, but compassion is something continually alluded to and described. It's not really something that can be taught so much as it's already there inside us, waiting for the right moment when, like the sun rising, everything is illuminated.
I've realized I've come to that point. After having a cousin diagnosed with systemic lupus erythematosus and a brother diagnosed with panic disorder, my first concern was for how they are managing personally. Was there any comfort I could offer out of my fund of knowledge, and as a loving caring family member? Recently a friend's mother was diagnosed with ovarian cancer, and is receiving treatment in St. Louis. Although I am curious about the details, they are of lesser concern to me than the way she and her mom are doing, and how I can show my support.
I don't think I was ever without a sense of human compassion. I guess what has happened is that I am comfortable with disease and suffering. Where once the disease was foreign and terrifying, it is now familiar to a point that I can concentrate more on the person and how it is affecting them and the family. There's also a new boldness I have found myself having with patients. In the pediatric pulmonary clinic this past Tuesday, I was interviewing a mother who was accompanied by her two boys and daughter, the oldest of which was four. The three children were running around the exam room, fighting, getting into things, and the mother was clearly exacerbated. I stopped my interview to put down the patient's (her 4 year old son) file and addressed the kids, focused on them, and was able to gain their attention and cooperation while I conducted the rest of the interview and physical exam. It was a huge reward to be able to feel as though I made a connection with the family, and the mother especially. Because, when all is done in medicine, it's not just how much better you feel after seeing the doctor, but how comfortable it was to get to that better place.
