I had spent 18 years in classrooms through my second year of medical school. In my third the clinics were upon us. Classroom time dropped to essentially nil.
The first clinical course, one I felt bad about, was internal medicine, a field with a knowledge base as wide as the universe. My shortcomings became quickly obvious in addition to my limited knowledge. A sickly patient had a cardiac arrest, clearly the first I had ever observed.
She quickly drew the attention of her resident, her intern, her nurses and me. I was asked in this life threatening event, “Rubin get the blood pressure.” The word “pressure” is the operative one here. I guess I got one but what shouts back at me is the first command to me under life threatening circumstances. It’s a moment one never forgets particularly after 18 years in the quiet of the classroom.
The first clinical course I felt good about was Ob/Gyn (OBG). It had a relatively finite knowledge base. Obviously, at that point my clinical knowledge was really finite. OBG’s relatively limited breadth made for just enough comfort in the world of the non-classroom, medical clinic. Additionally, the newborn delivery suite was by its nature a happy place. Finally our upbeat dean of the medical school, not surprisingly an OBG, was affectionately known as Smiley. He actually gave us OBG pathology lectures with vivid slides. My growing affinity for pathology continued with his teaching.
The most dramatic memories are those in which I delivered babies. Being schooled for six years to that point in the Deep South, the concept of a slippery greased pig was one I could appreciate. The metaphor was perfect for the newborns I handled in the delivery suite. I held on to them for dear life with those slippery gloves. Remarkably, they all survived.
My two best clinical stories come from my senior year experience at a little country clinic where I was privileged to work.
One night I was on call and a sniffling infant was carried into the clinic. He had a fever and you could hear his labored breathing from across the room. Perhaps a ten year old child would have recognized without the rales ( a crackling sound from the fluid-filled air sacs of the lung) I heard through the stethoscope, that, this child required a chest film. The sounds were characteristic of pneumonia, a life threatening condition.
The chest film showed the obvious characteristics of a pneumonia, a whiting out over what should have been a relatively black area of lung. The baby was properly and successfully treated at a hospital. His was the only life I actually may have saved in medical school. Any other student would have done the same thing. Nevertheless it was fulfilling.
The second story involved a man at the other end of the spectrum. He was old and achy. Specifically he complained of significant pain in his rear end. Somehow or other we established this was his first sign of a bona fide heart attack. It was the oddest presentation I would ever see or hear about. Life is full of surprises.
H. Robert Rubin, best-selling Amazon memoirist and author of Look Backward Angel, How Did I Get Through This? and Please Save the Third Dance for Me, all available on Amazon.