Memoirs of An Awkward Medical Student
An unfinished collection of anecdotes from my time at medical school
Lung cancer clinic: as fun as it sounds.
General medicine attachment. Fourth year.
It’s a grey and wintery Tuesday afternoon in a small provincial hospital in the middle of New Zealand. The room is like every other hospital clinic in existence: sterile and soulless. It’s lit with harsh fluorescent lights that emit a dull, pulsating hum, like a low note held on a church organ, filling the room with a crescendoing sense of dread. Or perhaps this feeling of unease stems from the topic of today's clinic: new diagnoses of lung cancer. This particular consultant schedules all of these appointments for the same afternoon each week because she “likes to get all the dreariness over in one sitting''. She is in her late thirties to early forties, which is young for her position, but her levels of cynicism are that of an 80 year old war veteran who's pension has just been cut off. Her thick accent suggests she originated somewhere in the north of England and like many other British doctors she has come to New Zealand in search of a better life. Clearly she hasn't found it. Her grouchy demeanor hasn’t stopped me growing fond of her on this attachment however; she is one of the only consultants that has taken the time to learn the students names and she makes an effort to engage us and encourage our learning.
The role of a medical student in any clinic is to try to become as much like a piece of furniture as possible. A consultant’s senses are akin to those of a tyrannosaurus rex; any movement makes you more noticeable and thus vulnerable to being asked questions. Occasionally you will have had the luxury of knowing that your attendance is expected at a particular clinic with ample time to read up on the likely cases, to provide you with armour to use against the inevitable onslaught of interrogation. However, more often than not, as was the case for this particular clinic, you are only alerted to this expectation roughly 20 minutes prior, so the less noticeable you are the better.
The afternoon proceeds in an expectedly macabre fashion. We see patient after patient, accompanied by their nearest and dearest, and deliver unto them the most catastrophic news of their lives. As evidenced by the ever-increasing expression of despair on Dr Groucho’s face, this really becomes a chore after the first one or two. She is the grim reaper and I am her grisly servant. My heart sinks heavier in my chest with each crying family that shuffles out of the room.
Our next victim is a 60-year-old Polynesian woman accompanied by her adult son. She has a round, deeply-lined face and deep brown eyes. As she enters she gives us a wide, warm smile, revealing crooked, nicotine-stained teeth. She is dressed in a multi-coloured, hand knitted cardigan embroidered with a floral pattern . Her son is her exact opposite - a rottweiler of a man. He’s broad and tall, dressed in a black singlet and motor oil-stained denim jacket emblazoned with gang patches. His head is covered in thick black dreadlocks. The stench of stale cigarette smoke tails them into the clinic. Dr G opens the consultation and wastes no time getting to the point.
“So unfortunately given your smoking history and the appearance of this chest x-ray, it is highly likely that you have lung cancer. We will need to take a biopsy to get a full diagnosis.”
A gloomy silence encompasses us all as this news sinks in. As with the rest of the consultations that day, I feel like a grim voyeur invading this incredibly private and life-changing moment for the sake of my own learning. Then the rottweiler growls:
“So you don’t actually know that it’s cancer then?”
His mother stays quiet, her head bowed in sombre resignation.
“No but that is the most likely scenario” replies Dr G.
“Well what the fuck are you talking about cancer for if you don’t actually know?”
“Based on my clinical experience I…”
She’s cut off.
“Maybe we shouldn’t be filling mums head with that negative shit until we know for sure. I mean it could be anything.”
“It could be something less sinister but the index of clinical suspicion is…”
“Oh don’t give me this bullshit doctor-speak. All we know is there is something on the x-ray and we need to get the b-b… what did you call it?"
“The biopsy?”
“The biopsy exactly... so why are we even talking about cancer”.
“It's important for your mother's sake that we prepare for the worst case... the most likely scenario. I don’t want to give either of you false hope.”
Their conversation continues back and forth like this for what feels like an eternity: The son growing more aggressive; the consultant growing more stern and matter-of-fact in her responses. They are two behemoths, one physical, one intellectual, dueling it out while the only one that should have been speaking, the patient, stays deafeningly silent. The level of conflict compounded with the mute despondency of the mother was almost too much for me to bear. Luckily the duo left without any bloodshed and the room was again permeated with silence. I’d sat through several lessons in medical school on dealing with difficult patient interactions and I was eager to hear what techniques this consultant had used in this situation (at least this should distract her from any difficult clinical questions she was planning on asking me). But before I can ask she turns to me.
“Well he was a bit of a dickhead wasn’t he? Looks like the kind of guy that is out at night nicking cars. I thought I had escaped people like that when I left Manchester. I mean honestly it’s not my fault your mum smoked like a bloody chimney her whole life. She probably smoked while carrying him as well, and drank, which would explain a lot.”
Rheumatology clinic: where dreams go to die.
I’m sitting awkwardly in a clinic room that smells as if it hasn’t had a window opened since it was constructed in the early sixties. It definitely hasn’t been graced with a decorator since then – who knew the palate of beige, off-white and brown was so extensive? The physician I have been assigned to sit with for the afternoon, Professor Martin Old-body the Third, a rheumatologist, seems to be the physical embodiment of a particularly dull shade of beige. Approximately six hundred years old, he is meek and gangly, and gives off a faint but distinctive odour of mothballs. His fragile frame is draped with an ill fitting, grey woolen suit that hangs down like the skin of an ageing bloodhound. His greying hair, parted in the middle, glistens with a thick coating of pomade. Completing the look are a pair of thick-rimmed tortoiseshell spectacles with a faded brown leather strap, which is presumably required to keep the glasses from escaping his dull, expressionless face. He’s the kind of man who fixates on a point just north of your eyebrows when he speaks to you, as if any eye-contact would cause an immediate expulsion of the contents of his colon. I can only wonder what glorious shades of beige would result.
We are waiting for the first patient of the day. There isn’t much in the way of small talk; rather I’m supplied with a pile of patient information leaflets to read while the Prof. completes some paperwork on his computer, using one finger at a time. The leaflets cover the wonders of rheumatology: Systemic Lichenous Earwig-a-matosis, Rheumabobulus Art-garfunkel-ulous, Misogynistic Egomaniacal Myelitis. None of these conditions are ringing a bell. My brain, trying desperately to escape the dire surroundings, thuds dully against the inside of my skull. The air is thick and stale and I’m convinced a dust mite just crawled out from Prof. Snaggletooth's mouth as he clears his throat for the fortieth time.
“Can this really be an ideal setting in which to see patients?” I think. I feel as though I’ve developed a particularly nasty form of interstitial lung disease just by sitting here. Outside I can hear the beeping of a nearby rubbish truck and the muffled laughter of some workmen. Maybe it’s not too late for a career change. A knock at the door symbolizes the first patient arriving. Finally the silence is laid to rest.