Inside Doctoring: Stages and Outcomes in the Professional Development of Physicians

By Robert H. Coombs; D. Scott May et al. | Go to book overview

Notes from Overground: Fourth Year at Harvard Medical School

Daniel J. Bressler

It is too late for first impressions and too early for memoirs, yet I want to try to leave some record of what I have learned in medical school. This is not an essay on electrolyte changes in chronic renal failure or the differential diagnosis of hemoptysis. Rather, it tells what one medical student gleaned incidentally, between the lines of the formal medical school instruction.

The last 31/2 years have changed the way I think of myself. I have gone from considering myself a "layperson" to thinking of myself as a physician. Much of this transformation is related to the body of information I have been so busy accumulating--information that has allowed me to participate in decisions concerning the welfare and fate of my patients. But a large part of the change is due to my exposure to "medical" experiences rather than to the accumulation of bits of information. These experiences are not listed in the medical school syllabus.

Suddenly I have found myself privy to the underbelly and the hidden thoughts of humanity. A modest grandmother has shown me the skin lesion on her inner thigh. I have heard the secret fears of an old man that he would never tell his wife of 50 years. I have caught babes first squeezed out from their mothers' wombs and held them as they gasped their first breath. I have stayed up late reading Shakespeare with a man who had cancer and was trying his best to die cheerfully. I have stared into the blank face of a pretty teenaged girl who could not understand why she kept slitting her wrists and overdosing on barbiturates.

What is most remarkable about these tales of close encounters is how "unremarkable" they are. Every medical student has a handful of such images and meetings by the time of graduation. I lay out these memories not to claim some special experience for myself, but to point out the privileged eyes and ears we are given. Amidst the

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